O'Shaughnessy, J.A. (2007). Management of febrile neutropenia and cardiac toxicity in the adjuvant treatment of breast cancer. Clinical Breast Cancer, 8(Suppl., 1), S11–S21.

The purpose of this review was to review guidelines for the supportive treatment of patients undergoing adjuvant breast cancer, and to evaluate strategies that can be used to improve the safety of these regimens.  All of the studies included were with patients receiving chemotherapy for breast cancer.

Databases used were not stated.

Key words used include anthracyclines, filgrastim, hematopoietic growth factors, myelosuppression, pegfilgrastim, cost/benefit analysis

The number of studies included in the report was 29.

Sample sizes were not reported.

One meta-analysis showed that adding G-CSF prophylactically during the first cycle of chemotherapy in patients being treated for various cancer types helped to decrease the rate of febrile neutropenia from 39% in the control group versus 22.4% in the G-CSF group and made chemotherapy more tolerable, allowing patients to get the appropriate dosages. Another trial compared patients receiving TAC versus FAC initially without G-CSF for either group; researchers did give G-CSF to patients in the TAC group after febrile neutropenia rates soared and rates of febrile neutropenia in the TAC group declined and the rate of trial completion of chemotherapy increased. CALGB9741 also was analyzed and it was discovered that patients receiving the two-week cycle with G-CSF, as compared to the three-week cycle, did remarkably better in declining rates of febrile neutropenia. Another phase III trial showed that patients receiving pegfilgrastim versus placebo had significantly lower rates of febrile neutropenia.

Many of the studies mentioned by the author contributed to the determination that G-CSF should only be given on day 2 due to the elimination period of the drug and that giving it earlier than day 2 may actually increase the risk of febrile neutropenia. The other studies cited in the article were different studies that all showed improvement of febrile neutropenia rates and increase compliance with therapy due to G-CSF.

G-CSF decreases the risk of febrile neutropenia in patients with cancer undergoing chemotherapy treatment. Chemotherapeutic regimens that are dose dense also benefits from G-CSF to decrease the risk of febrile neutropenia. These studies also determined that day 2 is the appropriate day to administer G-CSF, as giving it earlier may actually increase the risk of febrile neutropenia.